What is the best topical barrier cream for a stage 2 pressure ulcer on the buttocks?

Hydrocolloid or Foam Dressings Are the Best Topical Barrier Creams for Stage 2 Pressure Ulcers on Buttocks

For stage 2 pressure ulcers on the buttocks, hydrocolloid or foam dressings are recommended as the best topical barrier options to reduce wound size and promote healing. 1

Evidence-Based Selection of Dressing Type

Primary Recommendations:

• Hydrocolloid dressings: Superior to gauze dressings for reducing wound size (low-quality evidence) 1, 2
• Foam dressings: Provide similar complete healing rates to hydrocolloid dressings (moderate-quality evidence) 1, 2

Choosing Between Hydrocolloid and Foam:

• For minimally exuding wounds: Standard hydrocolloid dressings
• For moderately to heavily exuding wounds: Foam dressings
• Both options are cost-effective alternatives to more expensive treatments like platelet-derived growth factor dressings 2

Benefits of Recommended Dressings

Hydrocolloid Dressings:

• Create a moist wound environment that promotes healing
• Form a waterproof barrier that protects against contamination
• Require less frequent changing (can stay in place for several days)
• Self-adhesive properties reduce need for additional tape

Foam Dressings:

• Superior absorption for moderate to heavy exudate
• Provide cushioning effect that may reduce pressure
• Conform well to the buttocks area
• Generally comfortable and less likely to cause additional trauma when removed

Important Considerations for Application

1. Wound Cleansing: Prior to dressing application, clean the wound gently with normal saline 3
2. Wound Assessment: Document size, location, presence of necrotic tissue, exudate amount, and signs of infection 2
3. Skin Protection: Apply barrier cream to surrounding intact skin to prevent maceration
4. Secure Placement: Ensure proper adherence to prevent displacement, especially important for buttock location
5. Regular Monitoring: Check for signs of infection or deterioration

Adjunctive Measures to Improve Outcomes

• Nutritional Support: Protein supplementation can reduce wound size (weak recommendation, low-quality evidence) 1, 2
• Pressure Redistribution: Use appropriate support surfaces like air-fluidized beds 1, 2
• Repositioning: Regular repositioning to relieve pressure on the buttocks area 2
• Electrical Stimulation: Consider as adjunctive therapy to accelerate healing of stage 2-4 ulcers (weak recommendation, moderate-quality evidence) 1

Common Pitfalls to Avoid

1. Inappropriate Dressing Selection: Using gauze dressings, which are inferior to hydrocolloid or foam 1
2. Infrequent Assessment: Failing to regularly evaluate wound progress
3. Inadequate Moisture Control: Not addressing excessive moisture from incontinence, which can worsen buttock pressure ulcers 1
4. Ignoring Nutritional Status: Failing to provide protein supplementation when needed 1
5. Neglecting Pressure Relief: Not implementing proper positioning and support surfaces 2

Special Considerations for Buttock Location

• Incontinence Management: For patients with urinary/fecal incontinence, consider using a pH-balanced cleanser rather than soap and water 4
• Dressing Adherence: Select dressings with strong adhesive properties to prevent displacement during patient movement
• Infection Risk: Monitor closely for signs of infection due to proximity to perineal area

While the evidence for pressure ulcer treatments is generally of low to moderate quality, hydrocolloid or foam dressings represent the best current evidence-based options for stage 2 pressure ulcers on the buttocks 1, 2, 5.